title: Flap advancement and core fistulectomy for complex rectal fistula.
abstract: BACKGROUND
  The treatment of low fistula in ano is well accepted but controversy surrounds the management of high trans-sphincteric fistulas and more complex fistulas. This study assesses the clinical results of advancement flap techniques in association with core fistulectomy for complex fistula in ano.
  
  
  METHODS
  A retrospective analysis of the use of advancement flap techniques together with core fistulectomy in 25 patients (26 fistulas) was performed. Clinical outcome was assessed in terms of fistula healing, continence, failure and technical problems.
  
  
  RESULTS
  Successful healing of 20 of the 26 complex fistulas was achieved using this technique with no disturbance of continence and minimal (technical) complications.
  
  
  CONCLUSIONS
  Flap advancement and core fistulectomy is a safe, effective procedure for complex rectal fistulas with good functional results and minimal or no disturbance of continence, and should be considered for the treatment of complex perianal fistulas.
authors.affiliation: Department of Surgery, General Infirmary at Leeds, UK.
authors.forename: G V
authors.initials: GV
authors.lastname: Miller
authors.forename: P J
authors.initials: PJ
authors.lastname: Finan
mesh_terms: D000328:Adult; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome